By Brendan Pierson and Disha Raychaudhuri
(Reuters) – Companies accused of fueling the opioid crisis in the United States have so far paid more than $3 billion to compensate states, but has some of the money reached people? in need ? It depends where you live. Yes, if you are in Massachusetts; no, in Texas.
A series of landmark settlements since 2021 with major drug distributors, pharmacies and drugmakers, including Johnson & Johnson, set compensation totaling more than $50 billion nationwide.
More than 900,000 people have died from drug overdoses in the United States since 1999, with opioids playing an outsized role, according to data from the US Centers for Disease Control and Prevention. State and local officials have touted the settlements as providing desperately needed aid to communities hard hit by the crisis.
But when the money will be disbursed, and who will receive it, remains far from clear, Reuters found. And many of those who have worked with opioid addiction for years, through a patchwork of nonprofit treatment and support organizations across the country, say they still don’t know how and whether their work will benefit, according to a series of interviews over the past few months.
Reuters reached out to all 50 states and the District of Columbia to ask if they have a process for nongovernmental organizations to apply for settlement funding. He also looked for information available online about applying for funding.
Reuters received responses or was able to locate information online for 40 states and the District of Columbia. Of those, the news agency could only confirm that 16 had central, statewide, publicly available processes for organizations to apply for funding.
Some of the remaining states, including Maryland and Illinois, said they plan to open an application process soon. Others did not provide specific details on future plans. Arkansas has adopted a unique model; although the state does not have a funding application process, two-thirds of its settlement money goes to a partnership of state and local governments, which does have such a process.
Among the states where money is already flowing to organizations on the ground are Massachusetts, Kentucky and Arizona.
“The need to get that money out and start making a dent in the crisis has never been greater,” said Brandon Marshall, a professor of epidemiology at Brown University School of Public Health who serves as an adviser to the overseeing committee. Rhode Island Settlement. “I don’t quite understand why some states and jurisdictions take so long to create a process.” (Rhode Island disburses settlement funds through an ongoing series of application processes targeted at specific types of interventions.)
In Massachusetts, which state data shows has received more than $129 million this month, funds have already begun to flow, some through a public grant application process.
According to a public summary released after a December meeting of the advisory board overseeing the state settlement, the state allocated $3.4 million to purchase the overdose reversal drug naloxone, $1.2 million $5 million to methadone treatment programs and $5 million to organizations that provide long-term housing. people struggling with addiction. The state has also pledged $15 million to repay student loans for healthcare workers who provide drug treatment and continues to assess applications for additional grants.
“I think Massachusetts is doing an amazing job,” said Julie Burns, CEO of RIZE Massachusetts, a nonprofit that funds efforts to address the opioid epidemic. “Their process was very open.” (RIZE itself did not receive funding for the establishment.)
The fate of Texas’ share, more than $270 million received to date from December 2021, is less clear. The state legislature this year allocated about $22 million to government agencies for 2024 and 2025, and released an online form for organizations to register as potential funding recipients.
But the state said it does not expect to open grant applications until late this year or early next year.
“Texas is spending the funds wisely, not quickly,” Chris Bryan, spokesman for the office of Texas Comptroller Glenn Hegar, said in an email, adding that the state was seeking to avoid the fraud and misuse of money. He also noted that the state legislature, which only meets every two years, was not in session in 2022, pushing back spending decisions this year.
Lisa Ruzicka, coordinator of the Valley Hope Foundation, a Kansas-based nonprofit, said it follows her experience. While Valley Hope, which operates in seven states, successfully obtained a grant from Arizona and has been in contact with other states, it “has been very difficult to understand” how the Texas grant process works, Ruzicka said.
“I had a call with the Texas Attorney General for a while, and you just can’t get anyone to give you answers,” she said. The attorney general’s office did not respond to a request for comment.
DIFFERENT STATES, DIFFERENT STRUCTURES
The opioid settlements stem from thousands of lawsuits filed by state and local governments across the country, starting in 2017, against drug manufacturers, distributors and pharmacies — the largest mass litigation of its kind in the name of the public since states sued big tobacco in the 1990s.
Most of the settlements were national agreements, although some state and local governments pulled out and entered into their own separate agreements. Settlement companies include the three largest U.S. drug wholesalers, drug makers Johnson & Johnson and pharmacy operators Walgreens Boots Alliance Inc.
Most states share a significant portion of their total settlement funds with their city and county governments, which make their own independent decisions about how to spend.
The lack of clarity, so far, about how the money will be spent is reflected in the experiences of the more than a dozen advocates and workers struggling with opioid addiction who spoke to Reuters for this story. .
North Carolina has been widely praised for its transparency over opioid settlement funds, of which it has received more than $93 million so far, thanks to strict requirements for local governments, which will receive 85% of the money, to report on their spending decisions and an online dashboard where the public can track them. The state Department of Health and Human Services has already awarded more than $15 million in grants through a competitive application process.
Even there, however, the current state of settlement spending plans is not always clear. Associate Director Lauren Kestner of the Center for Prevention Services in Charlotte, which received an $800,000 state grant, praised the state’s overall approach but said some counties have not yet revealed much about their plans and that organizations like his had to rely on established relationships with officials for information.
“Those of us who were able to sit down to eat had to work” to get there, she said.
Tricia Christensen, policy director of the Community Education Group, a regional organization covering Appalachia, also praised states like Massachusetts and North Carolina, but said in others — she named Mississippi and Alabama – Drug treatment workers in the field have “no idea what’s going on. ”
A spokesperson for the Alabama attorney general’s office said state spending is a matter for the legislature and all funds will be used to address the opioid crisis. Mississippi officials did not respond to Reuters inquiries for this story.
Mississippi — unique among the states — has pledged 70% of its $203 million share of the distributor and the J&J settlement to a single recipient, the University of Mississippi Medical Center. He did not respond to a request for comment on how he planned to spend the money.
Another crucial part of the story is that settlement funds can be used for so-called harm reduction, such as providing clean syringes and test kits for fentanyl, which has not been authorized for federal government funding in the past. Even some conservative states, where harm reduction has been controversial, are becoming more open to the approach.
Harm reduction groups see the settlements as a chance to move from the fringes to the mainstream, but in some parts of the country they may face an uphill battle.
“For the first time, we’re told you can do needle services and you can use that money to do that,” said Marc Burrows of Challenges Inc, South Carolina’s only harm reduction organization providing needles. , to Reuters in March.
But in May, the board overseeing state opioid regulation rejected a joint request from Challenges and a county health department to fund harm reduction efforts, without explaining its decision. The board did not respond to a request for comment.
(Reporting by Brendan Pierson in New York and Disha Raychaudhuri; Editing by Alexia Garamfalvi and Claudia Parsons)